£18.99

per month

Gym Only DD

Personal Details

Title*

First Name*Last Name*

Date of Birth*GenderMaleFemale

Contact Details

Email Address*Confirm Email*

Mobile*Home Phone

Emergency Contact

Name

Phone

We will keep you up to date with all the latest news from the club and keep in touch with you at key points to help you
achieve your fitness goals.
Please tick if you do not wish to receive emails
or SMS

start date

Membership Details

By entering your details and confirming this mandate form, you authorise (A) Harlands Services Ltd.
to send instructions to your bank to debit your account and (B) your bank to debit your account in accordance with the
instructions from Harlands Services Ltd.

As part of your rights, you are entitled to a refund from your bank under the terms and conditions of your agreement with your bank.
A refund must be claimed within 8 weeks starting from the date on which your account was debited.

The company name which will appear on your bank statement against the debit will be: Harlands Services Ltd.

Please note your unique reference is:

Preview Direct Debit Instruction

Personal Details

Title:

First name:

Last name:

DOB:

Gender:

Contact Details

Email:

Mobile:

Phone:

Emergency Contact:

Emergency Phone:

Address Details

Agreement

I confirm that I am the account holder and can authorise debits from this account